Post COVID-19 Head and Neck Mucormycosis: MR Imaging Spectrum and Staging

Maha Ibrahim Metwally; Mohamed Mobashir; Ahmed Hassan Sweed; Sara Mohamed Mahmoud; Aya Gamal Hassan; Kamal ElKashishy; Mohamed Eesa; Ismail Elnashar; Ashraf Elmalt; Ahmed Ibrahim Elsayed; Shaimaa Khaled Idris; Al Shaimaa Fathi Elshetry

doi:10.1016/j.acra.2021.12.007

Post COVID-19 Head and Neck Mucormycosis: MR Imaging Spectrum and Staging

Acad Radiol. 2022 May;29(5):674-684. doi: 10.1016/j.acra.2021.12.007. Epub 2021 Dec 15.

Affiliations

¹ Lecturer of of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Egypt. Electronic address: aleenys009@gmail.com.
² Professor of Otorhinolaryngology-Head and Neck Surgery, Faculty of Human Medicine, Zagazig University, Egypt.
³ Lecturer of Otorhinolaryngology-Head and Neck Surgery, Faculty of Human Medicine, Zagazig University, Egypt.
⁴ Assistant lecturer of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Egypt.
⁵ Professor of Pathology, Faculty of Human Medicine, Zagazig University, Egypt.
⁶ Lecturer of of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Egypt.

Abstract

Objective: To develop a systematic approach for magnetic resonance imaging (MRI) analysis, imaging spectrum, and classification system for the staging of post-COVID-19 head and neck mucormycosis.

Method: The study included 63 post-COVID-19 patients with pathologically proven mucormycosis who underwent head and neck MR imaging. Three independent radiologists assessed the imaging spectrum of mucormycosis, MRI characteristics of sino-nasal mucormycosis, and extra-sinus extension, and submitted a final staging using a systematic approach and a proposed categorization system. A consensus reading was considered the reference imaging standard. The kappa statistics were used to assess the categorization system's diagnostic reliability.

Results: The overall interreader agreement of the MR staging system was very good (k-score = 0.817). MR imaging spectrum involved localized sino-nasal mucormycosis (n = 7 patients, 11.1%), sino-nasal mucormycosis with maxillo-facial soft tissue extension (n = 28 patients, 44.5 %), sino-nasal mucormycosis with maxillo-facial bony extension (n = 7 patients, 11.1%), sino-naso-orbital mucormycosis (n = 13 patients, 20.6%), and sino-nasal mucormycosis with cranium or intracranial extension (n = 8 patients, 12.7%). Extra-sinus extension to the orbit and brain did not have significant association with involvement of the posterior ethmoid/sphenoid sinuses and maxillo-facial regions (p > 0.05). MRI-based staging involved four stages: stage 1 (n = 7, 11.1%); stage 2 (n = 35, 55.6%), and stage 3 (n = 13, 20.6%), and stage 4 (n = 8, 12.7%). Involvement of the bone and MR-based staging were significant predictors of patients' mortality p = 0.012 and 0.033, respectively.

Conclusion: This study used a diagnostic-reliable staging method to define the imaging spectrum of post-COVID-19 head and neck mucormycosis and identify risk variables for extra-sinus extension.

Keywords: COVID-19; Magnetic resonance imaging; Mucormycosis; risk factors.

MeSH terms

COVID-19*
Humans
Magnetic Resonance Imaging
Mucormycosis* / diagnostic imaging
Orbital Diseases* / diagnosis
Reproducibility of Results